Estudio del paciente
alérgico
¿En quién se debe hacer un estudio de alergia?
Las personas que tienen síntomas de asma (o bronquitis o broncoespasmo), rinitis, conjuntivitis,
dermatitis atópica, urticaria, edema o inflamación, dermatitis de contacto, síntomas digestivos de dolor,
vómitos o diarrea más o menos intensa, reacciones con alimentos, medicamentos o con picaduras pueden
tener alergia. No todas las personas con esos síntomas tienen alergia, pues puede haber otras
causas.Hay más sospecha si los síntomas son prolongados, o si se van repitiendo con frecuencia, aunque entre medias se recupere totalmente.
También se sospecha si se nota relación clara entre tocar, respirar o comer alguna sustancia sospechosa y
la aparición de los síntomas.
Aunque no haya ninguna sospecha, si los síntomas son intensos, o frecuentes, o duraderos, o se presenta
alguna complicación, o si los síntomas limitan las actividades y disminuyen la calidad de vida, también
debe hacerse un estudio de alergia.
¿Qué sustancias (alergenos) se estudian
habitualmente?
Las sustancias que pueden causar alergia se llaman alergenos. Cuando se realiza un estudio de alergia se
comprueba si se está sensibilizado frente a los alergenos más frecuentes, que varían según la
enfermedad que se padezca, según la edad, según la zona de residencia.
Además de los alergenos frecuentes, también se estudian otros menos frecuentes, según los lugares y
ambientes a los que el paciente acuda con más frecuencia, aunque parezca que no causan síntomas,
y otros alergenos si el paciente o su familia han observado en algún momento alguna reacción
sospechosa.
¿Cómo se estudia una posible alergia?
Se utilizan las pruebas en piel, se realizan análisis de sangre de IgE total o IgE específica, se ponen parches en la piel, se realizan pruebas de función respiratoria, o se hacen pruebas de exposición, de provocación o tolerancia. Según los datos de cada paciente se hacen unas pruebas u otras, y el especialista las interpreta para decidir el diagnóstico y el tratamiento más adecuado.
¿Cuándo se repiten las pruebas y análisis?
Depende de cada paciente, de si los resultados son normales, anormales o dudosos, fuertes o débiles, de
los síntomas que tenga, etc. En algunas personas se repiten cada año, en otras cada dos o tres años o más, y en algunas personas se hacen una sola vez en la vida.
Pruebas en piel
¿Para qué se usan?
Las pruebas cutáneas se usan para averiguar si el paciente tiene IgE específica frente al alergeno
probado; las personas sin alergia no tienen IgE frente a ese alergeno. Si el paciente tiene IgE se dice que la
prueba es positiva y que el paciente está sensibilizado.
Si no da reacción, se dice que la prueba es negativa, que el paciente no le tiene alergia a ese alergeno.
¿En qué consisten?
Las pruebas en piel se realizan habitualmente en el brazo. Las más utilizadas se llaman “prick tests”. Se
pone una gota de líquido con el alergeno sospechoso, y se punciona la piel a través de la gota con una
lanceta cuya punta mide un milímetro. El alergeno penetra en la piel, y si se tiene alergia, al cabo de unos
15-20 minutos se forma una pápula, un abultamiento de la piel con enrojecimiento. Para ser considerada
alergia, la pápula ha de alcanzar un tamaño determinado, que habitualmente es de unos 3
milímetros de ancho.
¿Qué son el suero y la histamina?
Se ponen siempre dos pruebas de control o testigos.
Estas pruebas son con suero salino y con histamina.
La prueba del suero no tiene que dar reacción (prueba negativa), y la de histamina sí que tiene que dar una
pápula (prueba positiva). Si no es así, las pruebas no son válidas.
Si el suero da reacción puede deberse a que el paciente tiene una piel excesivamente sensible (esto
se llama dermografismo), frente a estímulos como el propio pinchazo, y si las sustancia probadas dan
reacción no puede determinarse que realmente sea por alergia sino por esa sensibilidad. Este resultado se
llama falso positivo.
La histamina da reacción en la piel de todas las personas, tengan o no alergia. Si la histamina no da
reacción es que la piel no está respondiendo bien, y puede que tampoco responda frente a las sustancias
que le causen alergia. Este resultado se llama falso negativo. Esto suele deberse principalmente a que el
paciente esté tomando alguna medicación.
¿Los medicamentos influyen en las pruebas?
Algunos medicamentos pueden alterar las pruebas y
hacer que no sean fiables. Los principales
medicamentos que las alteran son los antihistamínicos,
que se usan para la alergia, catarros, picores, síntomas gripales, el mareo, para dormir, etc. Hay que
intentar evitarlos desde siete días antes. En otro documento de esta web se muestran medicamentos
que alteran las pruebas.
Cuando vayan a hacerle pruebas dígale al especialista
todos los medicamentos que está tomando.
¿Son dolorosas las pruebas?
Estas pruebas pueden doler algo, aunque los niños suelen llorar más por el miedo que por el propio dolor.
Hay niños muy pequeños que no se quejan nada en absoluto.
Hace años se hacían las pruebas por intradermoreacción. En esta manera se inyectaba el
alergeno en la piel con jeringuillas, como se hace actualmente con la prueba de la tuberculina, y eran
bastante más dolorosas. Hoy en día también se usa la intradermoreacción, aunque con menos frecuencia.
¿A qué edad pueden hacerse?
A cualquier edad, incluso en niños de un mes de edad.
Hay una falsa creencia de que no pueden hacerse hasta los tres años o más. Esto no es cierto, se
pueden hacer a cualquier edad, y se deben hacer cuando haya alguna sospecha justificada.
¿Cuántas pruebas se hacen?
El número de pruebas se decide individualmente para cada paciente según el motivo de consulta y las sospechas que se tengan. Pueden variar desde tres hasta varias docenas.
¿Qué sustancias se estudian en las pruebas?
Las pruebas no son “automáticas”, sino individuales.
Es decir, no se hacen pruebas y automáticamente dan el resultado de todas las cosas a las que se tiene
alergia. Se estudia cada alergeno de forma individual:
si se quiere saber si se tiene alergia a una cosa, se hace una prueba; si se quiere saber si se tiene alergia
a dos cosas, se hacen dos pruebas, etc. Si se quiere saber si se tiene alergia a mil cosas, habría que hacer
mil pruebas.
Como esto no es posible, se estudian los alergenos habituales, y otros fuera de lo habitual si hay alguna
sospecha concreta; esas sospechas concretas deben comunicárselas al especialista antes de realizar las
pruebas. Si no las comunica, lo más probable es que no se le prueben.
Como ejemplo, después de hacerle pruebas no le pregunte al especialista si le ha salido alergia a la
berenjena o al calabacín, porque no se lo habrán estudiado si previamente no ha dicho sus sospechas.
¿Cómo se valoran las pruebas de piel?
Se valora el tamaño de la pápula, del abultamiento. Se valora tanto la anchura por sí misma como
comparándola con la histamina. Se suele exigir una anchura mínima de tres milímetros. El tamaño varía
desde apenas perceptible a 2 ó 3 centímetros, con formas muy irregulares.
¿Las pruebas fuertes coinciden con síntomas
intensos?
No siempre coinciden. Puede haber variaciones y desacuerdo entre los resultados de la piel y los
síntomas, de manera que algunas personas con pruebas grandes tienen pocos síntomas o incluso
ninguno y, viceversa, personas con pruebas poco importantes pueden padecer síntomas intensos y
frecuentes.
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Одной из составляющих хороших взаимоотношений является баланс брать-давать. Это о том, что мы вкладываем примерно столько сил, времени, ресурсов, сколько получаем взамен. Когда мы получаем отклик от мира, от людей, у нас волшебным образом появляются силы и желание давать больше. Мы чувствуем себя нужными, счастливыми, в гармонии с собой и миром.
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Истощение накапливается незаметно, медленно, но оно неутомимо приводит к неким последствиям.
Когда человек даёт больше, чем получает, то со временем в нём накапливается неудовлетворённость всем происходящим: “Я стараюсь, а меня не ценят”, “Я же всё делаю для всех, а чувствую себя таким несчастным”, “Они не благодарны”, “Я последнюю рубаху отдам, а мне никто не поможет” и т. д. И это ожидаемый эффект от такого неуважительного отношения к собственным ресурсам и потребностям.
Баланс – основа жизни. Он чрезвычайно важен как в природе, как внутри человеческого организма, так и во взаимоотношениях. Желаю всем найти этот баланс и никогда не терять его.
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